These commentaries by John Macgill represent his opinions only and not those of any Ettrickburn client.

Three Perspectives on Pharmacy and Mental Health

Pharmacy and the New GP Contract

Bordering on Problematic

Recognised by the Queen and her community

VACANCY Reporter/Researcher: Health and Care Policy in Scotland

Prescribing in Mental Illness – A Practice Pharmacist’s Perspective

What Matters to You? Communication in Pharmacy

Prescribing in Mental Illness – A Patient’s Perspective

Focusing the Vision: Dr Rose Marie Parr on the new strategy for Scottish pharmacy

All the things that could go wrong - looking ahead to the SNP conference

Ask Once, Get Help Fast? Pharmacy and Mental Health

Automation and Delegation in Pharmacy: Understanding the Moving Parts

Initiatives Highlight Potential of Community Pharmacy

Pharmacy First in Forth Valley One Year On

Trying to concentrate on the day job

Health and the Local Elections – a strange silence

The Pharmacist Will See You Now – The Growth of GP Pharmacy

Montgomery’s Review – Dr Brian Montgomery answers questions on access to new medicines in Scotland

An afternoon with SMC

Pharmacists at SMC

SMC – are drug firms voting with their feet?

Radical Surgery on the Horizon for Scotland’s NHS

The Future’s Bright – in General Practice

Community Pharmacy in a Changing Environment

Disclosing payments to doctors – has Sir Malcolm done the pharma industry a favour?

Health and Care in the First Minister’s Programme for Government

CMO: Scotland’s pharmacists “absolutely ideally placed” to practice Realistic Medicine

Profile: Maree Todd – MSP and Pharmacist

Scottish Parliament Health Committee Work Programme

Scotland’s new NHS – a Summer of Speculation

Scotland’s New Health Committee

Two million voices in Scotland – is integration the big opportunity to listen?

Medicines – levelling the playing field

Key appointment raises the bar for health & social care partnerships

What did our new MSPs do before?

SMC says no then NICE says yes – three times

SNP promises single formulary and a review of Scotland’s NHS

More Generous than the CDF – but less transparent

Comparison of Funds: New Medicines v Cancer Drugs

Bonfire of the Boards? SNP signals NHS Review

A tribute to five retiring MSPs

New Medicines Review - Health Committee sends findings to Government

Medicines New & Old in the Scottish Cancer Strategy

Great Ambitions, Slow Progress – New Models of Care in Scotland

Scottish Minsters Demand Up-Front Medicine Price Negotiation

Opportunity and Disappointment: MSPs Investigate New Medicines Access

Scottish NHS Strategy calls for 'Realistic Medicine'

The Scottish Model of Value for Medicines: Taking Everything into Consideration

When SMC Says No: An Access to Medicines Lottery

Reviewing the Review: Access to New Medicines in Scotland

A day of psephology and kidology

Insulting the Lifesavers

Worthy of Mention – Health and Science in the Honours List

News Silence from North of the Border

A Christmas PPRS Present from Pharma

Monday, December 18, 2017: Prescribing in Mental Illness – A Patient’s Perspective

This article is published by Pharmacy in Practice www.pharmacyinpractice.scot

A multi-disciplinary conference in the New Year will examine how Scotland can put patients with mental health conditions at the centre of medicines decisions and innovation. One of the speakers at the conference, giving a patient’s perspective, is Gordon Johnston a Board Member of the Mental Welfare Commission for Scotland. He has been telling Pharmacy in Practice, medication will always be one important option for treatment, but not the only one.

I think that we overprescribe in Scotland and particularly in mental health. I think a number of years ago there was a recognition that antidepressant prescribing, particularly, was too high and that for many people some sort of psychological therapy was probably more appropriate. The difficulty we have is that there is such a long waiting list still for those treatments, generally four to six months. And, even when people are referred for this type of treatment, GPs will still routinely prescribe an antidepressant while they are waiting. 

When I give the patients’ perspective at the conference, one of the things I’ll hope to promote is supported decision-making, where patients themselves are thoroughly and completely involved in making decisions about their own medication, rather than it simply being the professional as the expert telling them what they should be taking. 

One of the challenges is that GPs have to become much more knowledgeable about mental health and mental health medicines. Very often we find that, while GPs will challenge and change or reduce medication for lots of common physical health conditions, where something has been prescribed by a psychiatrist they tend not to touch it. We have seen cases of someone who has been prescribed something short-term while they were on a ward, still on the same medicine several years later simply because the GP thinks ‘if a psychiatrist said that they should take it, who am I to change it?’. 

I think the direction of travel is positive. We are recognising the skills of other professionals. If you want to have a chat about your medicines, why shouldn't you talk to a pharmacist rather than a GP? I think there is a bit of re-education needed for patients to understand that pharmacy is more than just the shop where you pick up your prescription. Pharmacists can be a very valuable source of information and advice.

I accept that some people may not want to be equal partners in decisions about their medicines. There are those who really don't want to know what medicines they are taking – they’re content to take the pink one in the morning and the blue one in the afternoon. Increasingly, though, as people become more educated about medical matters and more able to manage their own condition, they feel more able to challenge; to ask, for instance, that a medicine they are on is reduced or stopped. As for antibiotics and other medicines, we need to take more seriously whether people still need to be on a medicine for long periods. 

My own experience is fairly mixed in that I have been on and off a number of different medicines: some of which were very helpful at the time, and some of which were not. One very good psychiatrist once said to me that one should think of prescribing in mental health as an art-form rather than a science. Some medicines will work very well for one patient and simply do nothing for another patient with the same condition, yet the only way to know is to try it out.

Many of these drugs have serious side-effects that need to be monitored, so managing them is not just about mental health but also the physical aspects and the effects the medicine has on the body in other ways.

I think there always needs to be constant review of whether a medicine that was once appropriate for you, still is – or whether there should be a change. People’s conversations with healthcare professionals about their medicines for mental illnesses needs to continue for as long as they are taking them. My hope is that we can think about medicines as an ongoing discussion, the writing of the prescription being the beginning not the end of the matter. 

Mental Health in Scotland – Putting the Patients at the Centre of Medicines And Innovation takes place on Thursday 25th January 2018 at Stirling Court Hotel and Conference Centre, University of Stirling. Places are free for healthcare professionals. Register now at www.pharman.co.uk/events

 

The conference has been organised by Pharmacy Management and is sponsored by Sunovion Pharmaceuticals Europe. The agenda has been arranged by a steering group from within NHSScotland. The conference is non-promotional and the sponsor had no input to the agenda.